Gastric Stapling (Restrictive) Surgery

(Gastric Banding Surgery, Adjustable Gastric Banding, Vertical Banded Gastroplasty)

What is gastric stapling (restrictive) surgery?

Gastric stapling (restrictive) surgery is a type of bariatric surgery (weight loss surgery) procedure performed to limit the amount of food a person can eat. Bariatric surgery is the only option today that effectively treats morbid obesity in people for whom more conservative measures such as diet, exercise, and medication have failed.

In gastric banding surgery, no part of the stomach is removed and the digestive process remains intact. Either staples or a band are used to separate the stomach into two parts, one of which is a very small pouch that can hold about one ounce of food. The food from this "new" stomach empties into the closed-off portion of the stomach and then resumes the normal digestive process. Over time, the pouch can expand to hold two to three ounces of food. Because the size of the stomach is reduced so dramatically, this type of procedure is referred to as a restrictive procedure.

After gastric stapling or banding, a person can eat only about three-quarters to one cup of food. The food must be well-chewed. Eating more than the stomach pouch can hold may result in nausea and vomiting. Restrictive procedures pose fewer risks than gastric bypass procedures, but they are also less successful because continuous overeating can stretch the pouch so that it accommodates more food.

The types of gastric banding procedures include:

  • Adjustable gastric banding (AGB). This procedure involves attaching an inflatable band around the top portion of the stomach and tightening it like a belt to form a small pouch that serves as a new, much smaller stomach. After the procedure, the diameter of the band around the stomach can be adjusted by a physician by adding or removing saline (salt water). No staples are used in this procedure, which is relatively new in the U.S.

    Like other restrictive procedures, AGB may not achieve significant weight loss. The U.S. Food and Drug Administration (FDA) approved an AGB system in 2001 that can be put in place with a laparoscope (a small, thin tube with a video camera attached) rather than with an open incision for patients who are morbidly obese, as indicated by a Body Mass Index (BMI) of 40 or more.

  • Vertical banded gastroplasty (VBG). This procedure uses a combination of staples and a band to create the pouch. There is a dime-sized opening at the bottom of the "new" stomach that opens into the rest of the larger stomach. Plastic tissue or mesh is wrapped around the opening to help prevent the opening from stretching. Weight loss is about 45 percent of extra body weight at one year after the surgery.

  • Vertical sleeve gastrectomy (VSG). This procedure uses staples to remove a large portion of the stomach; the remaining stomach "sleeve" will hold approximately one-quarter cup of liquid. Over time, the stomach can expand to hold one cup of food.

    This procedure was created as a first step of a two-step surgery (second step surgery involves changing the direction of food in the small intestine for a malabsorption). Many patients lose the desired amount of weight and do not have the second surgery. Weight loss can be 33 to 80 percent of excess body weight at one year after surgery. Since the rest of the stomach has been removed, this procedure is not reversible.

VBG and AGB may be performed with a laparoscope rather than through an open incision in some patients. This procedure uses several small incisions and three or more laparoscopes to visualize the inside of the abdomen during the operation. The physician performs the surgery while looking at a TV monitor. Laparoscopic gastric surgery usually reduces the length of the hospital stay and the amount of scarring, and often results in quicker recovery than an "open" or standard procedure.

Persons with a BMI of 60 or more or persons who have already had some type of abdominal surgery are usually not considered as a candidate for the laparoscopic technique.

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